Provider Demographics
NPI:1093919342
Name:MYERS, KIMBERLY R (MSCCC-SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSCCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8803
Mailing Address - Country:US
Mailing Address - Phone:701-306-5829
Mailing Address - Fax:
Practice Address - Street 1:FARGO PUBLIC SCHOOLS
Practice Address - Street 2:700 7TH ST S
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-446-1000
Practice Address - Fax:701-446-1200
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1144235Z00000X
ND1001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist